As his first cancer radiation treatment approached, his Medicare Advantage was canceled
For many patients who trusted their Medicare Advantage plans would be a helpful way to ensure care for the long haul, many are finding critical disadvantages ranging from gaps in local provider access to a
Three Health Insurers Exaggerated Medicare Advantage Enrollees’ Illnesses, Overcharging Taxpayers $140 Million
The disadvantages of Medicare Advantage programs can extend beyond frustration for patients and lower reimbursement rates for hospitals. A recent report from the U.S. Health and Human Services Department Office of Inspector General put a
Why Medicare Advantage Plans are Losing More Providers
Medicare Advantage plans’ excessive denials, restrictive provider networks, and contentious contract negotiations continue to increase the number of health systems dropping MA plans. This new reality leaves patients frustrated and creates significant challenges for providers
Medicare Advantage Has Become Notorious for Prior Authorization Burden
Medicare Advantage plans denied 7.4 percent of medical professionals’ prior authorization requests, or about 3.4 million requests, according to a recent KFF analysis of 2022 data. With just 1 in 10 patients appealing these denials,
Ranking Medicare Advantage Insurers by Prior Authorization Denial Overturn Rates
While the majority of Medicare Advantage insurers overturn prior authorization denials when those decisions are appealed, the appeal process adds additional delays to care that can harm both hospitals and patients. A recent Becker’s article
Texas Leads Nation in Number of Counties with MA Penetration Exceeding 75 Percent
Of the 38 counties in the U.S where Medicare Advantage enrollment is 75 percent or more, six are in Texas, according to analyses by the Kaiser Family Foundation. Nationwide, Medicare Advantage penetration is, on average,
Medicare Advantage Plans Announce Major Lobbying Blitz
As Medicare Advantage plans face myriad challenges, including rising costs, negative media coverage, and increased lawmaker scrutiny, the health insurance industry is planning a major lobbying effort to boost support for the alternative to Traditional
Medicare Advantage Prior Authorization Requests Increase by Nine Million in Three Years
A recent Kaiser Family Foundation analysis found an increase in prior authorization requests from 2019 to 2022, along with a rising share of requests that were denied. Summary Prior Authorization Request Increase: More than 46
Medicare Advantage Plans Collect $50 Billion Through Home Visits
Becker’s Hospital Review summarized a recently released report from The Wall Street Journal that found Medicare Advantage plans collected $50 billion from diagnoses added to patients’ charts between 2018 and 2021, a third of which
2022 OIG report on Denials and Prior Authorization Concerns
A 2022 report from the Office of Inspector General examines the issue of prior authorization denials in Medicare Advantage plans. Here are the key findings: High Denial Rates: The report found that Medicare Advantage
Kaiser Family Foundation summary of Medicare Advantage trends and updates in 2024
The Kaiser Family Foundation summarized Medicare Advantage 2024 trends and updates in enrollment. Here are the main points: Enrollment Growth: In 2024, 32.8 million people are enrolled in Medicare Advantage plans, making up 54%
Humana tinkers with Medicare Advantage plans amid higher costs
As more seniors advance into Medicare eligibility, Humana noted decreases in its Medicare Advantage population leading to new consideration for how it will approach its commercial Medicare products. Changes, according to Modern Healthcare reporting,
